Generalised anxiety disorder higher among workers during economic downturn — Expert
Dr Lawal Kehinde is a consultant child and adolescent psychiatrist with the Department of Child and Adolescent Psychiatry, University College Hospital, Ibadan. He talks about panic disorder and its treatment in this interview with
hat is panic disorder?
According to the Diagnostic and Statistical
of Mental Disorders, Fifth Edition, panic disorder is a type of disorder that is characterised by recurrent unexpected panic attacks. In addition to experiencing a panic attack, at least one panic attack must be followed by one month or more of the person fearing that they will have more attacks. It is not uncommon for people to have a panic attack during sleep. A panic attack is usually very brief, often lasting less than three to five minutes. Panic disorder is one of the anxiety disorders.
There are regions of the brain that underlie our emotions. Any dysregulation in the functioning of those regions may predispose an individual to having a panic attack. Additionally, some people are more sensitive to the natural or normal bodily sensation that you and I experience. For instance, anyone could feel an itch but that feeling is more intense for someone who is likely to suffer a panic attack than for the general population, such that the mere experience of that itch makes them worry that something bad is going to happen to them. how does it affect the individual socially?
Panic disorder can be very debilitating. It can continue for months or years, depending on how and when treatment is sought. If left untreated, it may worsen to the point where one’s life is seriously affected by panic attacks and by attempts to avoid or conceal the condition. In fact, many people have had problems with personal relationships, education and employment while struggling to cope with panic disorder. Some people with panic disorder may conceal their condition because of the stigma of mental illness. In some individuals, symptoms may occur frequently for a period of months or years, and then many years may pass with little or no symptoms. In some cases, the symptoms persist at the same level indefinitely. are there known causes?
We know that panic disorder is associated with several conditions. The first thing is that it is important to rule out some medical conditions because some of the symptoms could be symptoms of underlined medical conditions. For instance, there is a condition called thyrotoxicosis, whereby the hormone that drives how fast our body metabolisms work can be high. So, if somebody has thyrotoxicosis, the person will have increased heart rates and other symptoms that could be mistaken for a panic attack.
Generally, it tends to run in the family, i.e. it has a genetic basis. In some cases, it is also associated with some psycho-active substance use, like nicotine, cigarette and cannabis. It could also be associated with intense psychological distress from any cause, including sexual abuse, difficulty at work or recurrent interpersonal difficulties. These can be termed as risk factors.
It is also associated with certain personality traits. Research has shown that there is some correlation between children with more fearful, anxious, or nervous personality types and later development of panic disorder. Nonetheless, the cause of panic disorder is unknown and many mental health professionals agree that it is most likely caused by a complex combination of environmental, biological and psychological factors. What are the major signs to look out for when a person has panic attack?
A panic attack is characterised by four or more of the following symptoms: palpitations, pounding heart or an accelerated heart rate, sweating, trembling or shaking, chest pain or discomfort, sensation of shortness of breath or smothering, nausea or abdominal distress. Others are feeling dizzy, unsteady, lightheaded or faint; feeling of unreality (derealisation) or being detached from oneself (depersonalisation); intense fear of dying, dumbness or tingling sensations and a general feeling of nervousness.
The affected person may feel that they are losing control. So, it is a very disturbing experience. Multiple panic attacks could result in a panic disorder. Sometimes, because of the nature or how severe it is, individuals may dread the recurrence of a panic attack. Imagine that you are outdoor, shopping or at a business meeting and you suddenly have a panic attack. You would feel ashamed that everybody is looking at you. So, the fear of having a panic attack could make people isolate themselves, feel depressed and (it may) even interfere with their daily activities. Generally, symptoms may be expected when panic attacks are provoked by exposure to certain situations. In other instances, panic attacks are unexpected. there have been growing concerns about imminent job losses in Nigeria due to the poor state of the economy. Can such concerns increase the risk of panic attacks among Nigerians?
The answer is yes. Anything that perturbs the mind can be associated with a panic disorder. We don’t particularly know why it happens. but if somebody is unduly worried about their means of livelihood, it could lead to panic attacks. On the socioeconomic situation in Nigeria, it is not impossible that it could be connected to a panic attack because having a job is one of the things that give one fulfilment and the threat of losing that could be very disturbing. Generalised anxiety disorder higher among workers during economic downturn. Is panic disorder genetic?
The evidence for genetics in causation of panic disorder is further strengthened by studies among twins that show a higher likelihood of the second twin having panic disorder, if the first twin already has it in monozygotic twins compared with dizygotic. Is panic disorder common in a certain age group?
Not particularly, it can occur at any age. but it typically develops between the ages of 18 and 35. Women are generally more affected than men. Why?
It could be that men and women socialise differently. Men are taught from a younger age not to be weak. but women are more expressive with what they go through. Additionally, hormonal factors may be involved. how can the condition be diagnosed?
basically, a person suffering from a panic attack needs to see a psychiatrist and have a complete evaluation. It is very important that medical conditions are excluded because some medical conditions could mimic a panic attack. Hypertension and cardiovascular problems could mimic a panic attack. how can panic disorder be treated?
One of the main ways of treating panic disorder is to use medication to control the agitation and intense fear and there is a specific class of medication that we use. On the long term, however, it is very important to combine medications with a form of treatment called psychotherapy, usually the type called cognitive behavioural therapy.